Leo (Leoberry) - the high doser
- Thread starter JeffJ
- Start date
JeffJ
Very Active Member
Leo's health
Leo is almost unresponsive to Levemir, I might as well be dosing him water. 17 units/dose now, and not very effective. Maybe I got a bad batch? I doubt it. Levemir pens expire in 2018 and are brand new. Neuropathy is pretty bad. Maybe I'll go back to Lantus after the SRT. The PZI was stupidly expensive, but worked. Maybe at low doses we'll go for it.
Colorado State University plan and notes from discussion
Beatrix Janei - Radiology Resident, assigned to Leo for SRT, phone meeting today 9/9/2016.
Monday 9/19 - Friday 9/23 treatment is scheduled (appointment moved up one week)
1) Schedule
Mon - exam, bloodwork, patient review, setup for Tuesday
Tue - imaging via CT. If successful, then no MRI needed. If unclear, then MRI required.
Wed - Fri - SRT treatments, 20 minutes each, anesthetized each time, and during imaging on Tuesday.
Friday: checkout. Can start the drive home if checkout is early enough.
Leo is released each day, and will spend evenings in the hotel with me. It will be a challenge to ensure he pees into the litter box. He is pretty good at home.
2) Prices
$1400 - CT scan, if successful and clear then no MRI needed
$600 - MRI if needed
$4,000 - SRT in 3 treatments, high dose, focused radiation
--------
$5,400 - $6,500
I think there are exam costs too. So previous estimates were $7,000 - $8,000.
Care Credit is accepted. We are to call the front desk to set it up = 970-297-5000
3) Objectives and notes
There is a gain of 600 days median survival rate. (JJ comment: maybe we caught Leo early, so it could be longer?)
All SRT cats become more responsive to insulin. SRT stops the tumor from growing and producing.
Neuropathy could get better once the cat is responsive to insulin.
BG must be monitored closely after SRT, and dosage adjusted.
4) Side effects
No immediate side effects.
Could develop 8 weeks later, swelling or some neurologic effects like seizure. In that case steroids are prescribed.
Late side effect is brain necrosis around the radiated area. 1% of cases. Irreversible. Occurs 1 year later.
5) Acro cats vs others
They treated 4 Acro cats in 2015. She said Acro is not diagnosed/treated, or people just don't go to CSU for treatment. (JJ: probably too expensive for the bulk of the population).
They treat other tumors in cats far more frequently, bladder tumors, etc.
If Leo gets there and no tumor is found, they will consult with me to determine other treatment options. Based on my knowledge from this forum, I doubt there are any. Leo has obvious Acro symptoms, elevated IGH-1, and physical signs.
6) Personnel
She said as a radiology resident, most of her day is spent in front of a computer, or at the equipment. As a result, other employees do the prep and exam work. There are also anesthesiologists.
7) Equipment
She said there is spare time around the equipment. I'll take a bunch of pics and geek out.
8) Comments
If you've read this thread, you know our recent losses
- July 1, Scoobs, our 8 year old sweetie
- August, Puma, a 10 year old Siamese we tried to rescue, who died the same day from starvation and exposure
- August 30, my Mom
We need to sustain some life. It will cost money. We'll use Care Credit to spread it out. I have appreciated everyone's condolences and support throughout this journey.
Leo is almost unresponsive to Levemir, I might as well be dosing him water. 17 units/dose now, and not very effective. Maybe I got a bad batch? I doubt it. Levemir pens expire in 2018 and are brand new. Neuropathy is pretty bad. Maybe I'll go back to Lantus after the SRT. The PZI was stupidly expensive, but worked. Maybe at low doses we'll go for it.
Colorado State University plan and notes from discussion
Beatrix Janei - Radiology Resident, assigned to Leo for SRT, phone meeting today 9/9/2016.
Monday 9/19 - Friday 9/23 treatment is scheduled (appointment moved up one week)
1) Schedule
Mon - exam, bloodwork, patient review, setup for Tuesday
Tue - imaging via CT. If successful, then no MRI needed. If unclear, then MRI required.
Wed - Fri - SRT treatments, 20 minutes each, anesthetized each time, and during imaging on Tuesday.
Friday: checkout. Can start the drive home if checkout is early enough.
Leo is released each day, and will spend evenings in the hotel with me. It will be a challenge to ensure he pees into the litter box. He is pretty good at home.
2) Prices
$1400 - CT scan, if successful and clear then no MRI needed
$600 - MRI if needed
$4,000 - SRT in 3 treatments, high dose, focused radiation
--------
$5,400 - $6,500
I think there are exam costs too. So previous estimates were $7,000 - $8,000.
Care Credit is accepted. We are to call the front desk to set it up = 970-297-5000
3) Objectives and notes
There is a gain of 600 days median survival rate. (JJ comment: maybe we caught Leo early, so it could be longer?)
All SRT cats become more responsive to insulin. SRT stops the tumor from growing and producing.
Neuropathy could get better once the cat is responsive to insulin.
BG must be monitored closely after SRT, and dosage adjusted.
4) Side effects
No immediate side effects.
Could develop 8 weeks later, swelling or some neurologic effects like seizure. In that case steroids are prescribed.
Late side effect is brain necrosis around the radiated area. 1% of cases. Irreversible. Occurs 1 year later.
5) Acro cats vs others
They treated 4 Acro cats in 2015. She said Acro is not diagnosed/treated, or people just don't go to CSU for treatment. (JJ: probably too expensive for the bulk of the population).
They treat other tumors in cats far more frequently, bladder tumors, etc.
If Leo gets there and no tumor is found, they will consult with me to determine other treatment options. Based on my knowledge from this forum, I doubt there are any. Leo has obvious Acro symptoms, elevated IGH-1, and physical signs.
6) Personnel
She said as a radiology resident, most of her day is spent in front of a computer, or at the equipment. As a result, other employees do the prep and exam work. There are also anesthesiologists.
7) Equipment
She said there is spare time around the equipment. I'll take a bunch of pics and geek out.
8) Comments
If you've read this thread, you know our recent losses
- July 1, Scoobs, our 8 year old sweetie
- August, Puma, a 10 year old Siamese we tried to rescue, who died the same day from starvation and exposure
- August 30, my Mom
We need to sustain some life. It will cost money. We'll use Care Credit to spread it out. I have appreciated everyone's condolences and support throughout this journey.
Madrona and Leda (GA)
Very Active Member
Sounds like you have a solid plan, best of luck!
JeffJ
Very Active Member
Thanks. I'll post updates when they happen, like the start of the trip. I've been handling my Mom's stuff. There's the obits which are done, the grief part, then the plan for the household in Sequim (I live in Austin, TX). My sister will help me in late October with that. She posted a touching story (at the bottom):
https://www.lastingmemories.com/memorial/carol-ahrens?story
Leo:
PMPS was 435 today. It was 13 hours (shot to shot) instead of 12 hours. Leo is not doing well. I've increased Zobaline to 4 tabs/day. Such a trooper. We brush and rub him a bunch each day. He purrs all the time. Oh my sweet boy.
I wish I could get him to 200-250. Oh well, 8 more days and I'll be in Fort Collins.
.
https://www.lastingmemories.com/memorial/carol-ahrens?story
Leo:
PMPS was 435 today. It was 13 hours (shot to shot) instead of 12 hours. Leo is not doing well. I've increased Zobaline to 4 tabs/day. Such a trooper. We brush and rub him a bunch each day. He purrs all the time. Oh my sweet boy.
I wish I could get him to 200-250. Oh well, 8 more days and I'll be in Fort Collins.
.
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julie & punkin (ga)
Very Active Member
I read your tribute to your mom - it was lovely.
It can seem like that, but I'm not sure you can be certain how low the dose is taking Leo. I know you said earlier that you weren't looking for dosing advice. How are you making the decision on what to do with his dose? I'm going to make some general observations for things I have seen with other acro cats, even though you've said you're not looking for help.
Too much insulin can look just like not enough insulin. There are quite a few counter-intuitive things about how a diabetic cat "works" and this little fact is one of them. Too much insulin can actually cause high numbers.
The way to prevent giving too much insulin is to always be confident of how low the current dose is taking the cat's blood sugar before one increases. That means catching nadirs on each dose - which means seeing how low the cat goes in between bounces and giving enough time on a dose that New Dose Wonkiness has passed - before you increase the dose.
Even in the circumstance where we are encouraging someone to fast-track a cat because the cat is stuck in high numbers, unless the circumstance were really unusual (which I haven't seen this happen yet in 5 years) people give at least 4 cycles of each dose before they increase. I wouldn't suggest fast-tracking for any cat that isn't having a minimum of 4 tests per day - both preshots and at least one test in the pm cycle. Missing any tests in the pm cycle prevents one from being certain how low their cat is going.
I want to strongly encourage you to post over on the Lantus/Lev group. Even though you think it's busy, which it is, people work hard to keep track of each other so that no one falls through the cracks. I see how much you love Leo and you are willing to go the extra mile for him, but surely you want to learn what you need to know to take care of a a him as a high dose cat. You don't know those things yet. The best way for you to learn what you need to know is to post there, learn more about how Lev works, and to read up on and track the other high dose cats there. For Leo's sake, I hope you will.
It can seem like that, but I'm not sure you can be certain how low the dose is taking Leo. I know you said earlier that you weren't looking for dosing advice. How are you making the decision on what to do with his dose? I'm going to make some general observations for things I have seen with other acro cats, even though you've said you're not looking for help.
Too much insulin can look just like not enough insulin. There are quite a few counter-intuitive things about how a diabetic cat "works" and this little fact is one of them. Too much insulin can actually cause high numbers.
The way to prevent giving too much insulin is to always be confident of how low the current dose is taking the cat's blood sugar before one increases. That means catching nadirs on each dose - which means seeing how low the cat goes in between bounces and giving enough time on a dose that New Dose Wonkiness has passed - before you increase the dose.
Even in the circumstance where we are encouraging someone to fast-track a cat because the cat is stuck in high numbers, unless the circumstance were really unusual (which I haven't seen this happen yet in 5 years) people give at least 4 cycles of each dose before they increase. I wouldn't suggest fast-tracking for any cat that isn't having a minimum of 4 tests per day - both preshots and at least one test in the pm cycle. Missing any tests in the pm cycle prevents one from being certain how low their cat is going.
I don't think that this is an issue of the Levemir not working. Either you're missing the low points and he's getting lower than you think on the Lev, or his insulin dose needs are higher than he's at right now. I don't know what you mean about "maybe at low doses we'll go for it." Are you thinking about switching to PZI and decreasing his dose?
I want to strongly encourage you to post over on the Lantus/Lev group. Even though you think it's busy, which it is, people work hard to keep track of each other so that no one falls through the cracks. I see how much you love Leo and you are willing to go the extra mile for him, but surely you want to learn what you need to know to take care of a a him as a high dose cat. You don't know those things yet. The best way for you to learn what you need to know is to post there, learn more about how Lev works, and to read up on and track the other high dose cats there. For Leo's sake, I hope you will.
JeffJ
Very Active Member
PMPS = 510
then 17.5 units for his PM dose
This is the first over 500 since switching to Levemir. The missed shot (fur shot) this morning did it. The 510 value is +(100-200) over normal PMPS. So the insulin is having an effect, just not enough. I will take him to 20 units max. By then he will be at CSU (with me) getting treated.
then 17.5 units for his PM dose
This is the first over 500 since switching to Levemir. The missed shot (fur shot) this morning did it. The 510 value is +(100-200) over normal PMPS. So the insulin is having an effect, just not enough. I will take him to 20 units max. By then he will be at CSU (with me) getting treated.
julie & punkin (ga)
Very Active Member
We posted at the same time.
With a fur shot this morning, I would encourage you to stay at the 17.5u for at least 4-6 consecutive cycles - which means starting the count tonight as the 1st cycle. This is a depot insulin, which means that interruptions - like a fur shot - make your cycle count start over.
With a fur shot this morning, I would encourage you to stay at the 17.5u for at least 4-6 consecutive cycles - which means starting the count tonight as the 1st cycle. This is a depot insulin, which means that interruptions - like a fur shot - make your cycle count start over.
JeffJ
Very Active Member
Ok. Thanks for the advice Julie. He hasn't been having very low nadirs. But I'll stay at 17.5 for 6 cycles. I felt so bad with the fur shot, but ya can't reshoot.
I have read your post twice. I do appreciate the advice. I want this thread in the acro forum so people see it in the future. This is mostly an acro and SRT thread (although I do get sidetracked. I did read multiple acro articles. The insulin molecules in acro are displaced by IGH-1. I understand that the externally applied insulin is then trying to outnumber/displace that extra IGH-1.
"Maybe at low doses we'll go for it (for PZI)." Well the PZI was almost 3x expensive. At 17u per dose I just can't afford it, and a vial would only last 12 days. At 1-4u per dose, I might switch back after the SRT. Leo seemed to respond the best to PZI. The feature I like with Levemir is that it is easy to obtain.
I might do a 12 hour on him on Tuesday. I need to spend time on my computer job contracts too. I'll continue to test 3x a day minimum.
Thanks for the kudos on my Mom's tribute. I hope she can see it too.
I have read your post twice. I do appreciate the advice. I want this thread in the acro forum so people see it in the future. This is mostly an acro and SRT thread (although I do get sidetracked. I did read multiple acro articles. The insulin molecules in acro are displaced by IGH-1. I understand that the externally applied insulin is then trying to outnumber/displace that extra IGH-1.
"Maybe at low doses we'll go for it (for PZI)." Well the PZI was almost 3x expensive. At 17u per dose I just can't afford it, and a vial would only last 12 days. At 1-4u per dose, I might switch back after the SRT. Leo seemed to respond the best to PZI. The feature I like with Levemir is that it is easy to obtain.
I might do a 12 hour on him on Tuesday. I need to spend time on my computer job contracts too. I'll continue to test 3x a day minimum.
Thanks for the kudos on my Mom's tribute. I hope she can see it too.
julie & punkin (ga)
Very Active Member
Oh, I think I understand - do you mean that if he gets to a low dose post-SRT that you might switch then?
We had a gradual decline in dose - Punkin got down to 4ish units, although I hadn't seen SRT-response in action at the time and I reduced his dose in advance. Knowing what I have seen since then, it would've been better for him if I had waited until he earned a reduction and THEN reduced the dose. But I didn't have the experience of seeing how other post-SRT kitties did at that time. He probably needed to be at a slightly higher dose and getting more into green numbers before I reduced. We all do the best we can, with what we know at the time. I don't think it made any difference in the long run.
julie & punkin (ga)
Very Active Member
I wanted to flag a post for you on Glucose Toxicity. Glucose Toxicity develops when a cat's body stays too long in higher ranges, and it begins to "think" that those higher numbers are normal. Then the dose has to be increase even more to break through and get the blood sugar back down into normal range.
It's just a good thing to understand.
It's just a good thing to understand.
JeffJ
Very Active Member
Thanks Alexi and Julie. A pretty tough year, but some nice stuff like Little Dude our new leg lovin' boy with copper eyes.
PZI - sorry this was unclear. Yes, if Leo goes to lower doses, then maybe we will switch back to PZI. PZI is so expensive, but he responded better. Leo has not been into the (100-200) range in forever, even at 17u. I suppose he could have Glucose Toxicity and Insulin Resistance, but it can't be fixed this week.
4 days to departure.
- got some chores done around the house so Theresa is ready to take care of the 2 dawgs, and also Little Dude, and Chinus
- Care Credit was setup at home today, will call them tomorrow to set it up at CSU
- will finalize dates and tickets to process Mom's stuff with my sister. That will be 7-9 days at the end of October. Theresa will be handling Leo and insulin while I'm gone.
- tomorrow is 5 hours of onsite work, so no 12 hour curve
Theresa and I lit the memorial candle tonight - for Scoobs, Puma, Punkin, and other GA cats on the forum. I also read thru Punkin's last day. What a great attempt you did to keep him alive. I especially liked this pic: http://s345.photobucket.com/user/yachiwycoff/media/IMG_0187.jpg.html
PZI - sorry this was unclear. Yes, if Leo goes to lower doses, then maybe we will switch back to PZI. PZI is so expensive, but he responded better. Leo has not been into the (100-200) range in forever, even at 17u. I suppose he could have Glucose Toxicity and Insulin Resistance, but it can't be fixed this week.
4 days to departure.
- got some chores done around the house so Theresa is ready to take care of the 2 dawgs, and also Little Dude, and Chinus
- Care Credit was setup at home today, will call them tomorrow to set it up at CSU
- will finalize dates and tickets to process Mom's stuff with my sister. That will be 7-9 days at the end of October. Theresa will be handling Leo and insulin while I'm gone.
- tomorrow is 5 hours of onsite work, so no 12 hour curve
Theresa and I lit the memorial candle tonight - for Scoobs, Puma, Punkin, and other GA cats on the forum. I also read thru Punkin's last day. What a great attempt you did to keep him alive. I especially liked this pic: http://s345.photobucket.com/user/yachiwycoff/media/IMG_0187.jpg.html
julie & punkin (ga)
Very Active Member
Aw, that was sweet of you to look up Punkin's story. That's one of my very favorite pics of him - he was a noble, dignified cat - majestic even, when he was younger.
I'll be sending you all my best thoughts and healing wishes when you go to CSU next week.
I'll be sending you all my best thoughts and healing wishes when you go to CSU next week.
JeffJ
Very Active Member
Trip is laid out:
Sept 17 - Austin to Amarillo, 485 miles, hotel booked
Sept 18 - Amarillo to Ft. Collins via 287 = 480 miles, hotel selection tomorrow
Sept 18-23 - Ft Collins
Sept 23 - Ft Collins to Amarillo
Sept 24 - Amarillo to Austin
15-16 hours driving time one direction, oh joy
7 nights of hotel, $110/night = $800 estimate
Cat supplies:
1) Leo will be crated in a 3' x 3' x 2' high doggie cage during the ride. Open wires.
I might make him a box so he can lay on it or under it. The upper tier would allow him to see.
2) The cage will house the litter box as well. The litter box has no top.
3) Cat carrier, plastic, with front door, for car-to-building moves.
4) Paper towels, towels, newspapers, litter, food, patience
5) insulin, test kit, hypo kit, B12
6) gas mask for times he does a stinker. Lately they could clear out a theater
7) Music for Cats - David Teie's Music for Cats see pic
He has occasional "accidents", and they are 1-2 cups of pee. So I'm tarping off the whole back of the SUV. Nothing worse than cat pee.
350+ BG for Leo all day today. He got real cranky when we cleaned his back foot. He always does. He stepped right in fresh pee spot in the litter box sometime today, and it was crusted and dried into his toes. He gets pissed off whenever we deal with his back feet. Poor kid. But his feet are clean now. It's the neuropathy. He was so fastidious before all of this. My poor sweet fur kid.
Theresa was all worried tonight that something could happen up in Colorado and he won't come back. I explained the procedure. There is a chance for later side effects, but he will be returning to Austin alive.
Chinus helped me type this. She cried for 2 days after our last return from vacation. She hasn't left my side. Such loyalty is so humbling.
Sept 17 - Austin to Amarillo, 485 miles, hotel booked
Sept 18 - Amarillo to Ft. Collins via 287 = 480 miles, hotel selection tomorrow
Sept 18-23 - Ft Collins
Sept 23 - Ft Collins to Amarillo
Sept 24 - Amarillo to Austin
15-16 hours driving time one direction, oh joy
7 nights of hotel, $110/night = $800 estimate
Cat supplies:
1) Leo will be crated in a 3' x 3' x 2' high doggie cage during the ride. Open wires.
I might make him a box so he can lay on it or under it. The upper tier would allow him to see.
2) The cage will house the litter box as well. The litter box has no top.
3) Cat carrier, plastic, with front door, for car-to-building moves.
4) Paper towels, towels, newspapers, litter, food, patience
5) insulin, test kit, hypo kit, B12
6) gas mask for times he does a stinker. Lately they could clear out a theater
7) Music for Cats - David Teie's Music for Cats see pic
He has occasional "accidents", and they are 1-2 cups of pee. So I'm tarping off the whole back of the SUV. Nothing worse than cat pee.
350+ BG for Leo all day today. He got real cranky when we cleaned his back foot. He always does. He stepped right in fresh pee spot in the litter box sometime today, and it was crusted and dried into his toes. He gets pissed off whenever we deal with his back feet. Poor kid. But his feet are clean now. It's the neuropathy. He was so fastidious before all of this. My poor sweet fur kid.
Theresa was all worried tonight that something could happen up in Colorado and he won't come back. I explained the procedure. There is a chance for later side effects, but he will be returning to Austin alive.
Chinus helped me type this. She cried for 2 days after our last return from vacation. She hasn't left my side. Such loyalty is so humbling.
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JeffJ
Very Active Member
Got some of the supplies together today. Staged the big dog cage in the car with the litter box. There will be a small second story for Leo in case he wants to look outside while he is sleeping. Theresa thoroughly inspected and approved the setup.
Tomorrow, we'll drive around with me in the back. I will identify all the places the darned cage rattles. And I'll wrap them with twist ties to keep me and Leo sane for 32 hours of driving.
Booked a cheapie hotel in Ft. Collins, $60 a night. Hey, I'm not moving there, just sleeping for 5 nights.
Thursday a.m. - Little Dude gets his second vet visit. Let's hope they confirm the ear mites are gone. He is dying to come inside. Our little love bug.
Tomorrow, we'll drive around with me in the back. I will identify all the places the darned cage rattles. And I'll wrap them with twist ties to keep me and Leo sane for 32 hours of driving.
Booked a cheapie hotel in Ft. Collins, $60 a night. Hey, I'm not moving there, just sleeping for 5 nights.
Thursday a.m. - Little Dude gets his second vet visit. Let's hope they confirm the ear mites are gone. He is dying to come inside. Our little love bug.
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Safe travels on your trip and best of luck. I found spraying Feliway in the carrier and using Rescue Remedy for pets on the morning feed really helped Neko calm on the drive. Ours was 3 days of 9 hour each driving and she used to hate driving. We did bond even more during the trip, which is a side effect several have noted.
I found extra towels and pee pads also invaluable for the ride. Once Neko got over the first day jitters she was pretty good about using the litter box, but only when we stopped the car (for gas/food). Not all cats will eat during the trip, but she was pretty good about it. Especially the high carb food on the way back. Yes, my little stinker was unusual and started dropping her insulin needs right away. Nothing like trying to get to an open pullout when traffic is baced up due to a forest fire. Anyway, fun times! For most cats it takes at least 2 weeks to see any SRT effect and I've seen some cats have to continue to up in dose for a couple of months before the radiation does it's magic. The SRT is neutering the tumor cells, not killing them, so you have to wait for the life cycle to play out.
I found extra towels and pee pads also invaluable for the ride. Once Neko got over the first day jitters she was pretty good about using the litter box, but only when we stopped the car (for gas/food). Not all cats will eat during the trip, but she was pretty good about it. Especially the high carb food on the way back. Yes, my little stinker was unusual and started dropping her insulin needs right away. Nothing like trying to get to an open pullout when traffic is baced up due to a forest fire. Anyway, fun times! For most cats it takes at least 2 weeks to see any SRT effect and I've seen some cats have to continue to up in dose for a couple of months before the radiation does it's magic. The SRT is neutering the tumor cells, not killing them, so you have to wait for the life cycle to play out.
JeffJ
Very Active Member
Thanks Wendy. Good suggestions. Tomorrow is a prep day. The whole trip is in the U.S., so I can always stop at a store if needed. That's good info about eating and elimination. We'll see how it goes with leo.
Post SRT will be interesting. You have Neko regulated. Leo is still not regulated. I beat myself up about it. It has caused his neuropathy. With luck we will see numbers start dropping. I'll review the spreadsheets again. Post SRT I will reduce food to help drive numbers down. He has not gained weight. Still 16.5 pounds.
Little Dude the Love Bug is free of ear mites! He does have leftovers in his ears. The vet applied BNT ointment. Little Dude does NOT let us in his ears. This should fix any fungus or infection in his ears. He did have chronic ear mites when we first got him. In summary, now he can become an inside/outside cat. We will wait until I return to introduce him to Leo.
Post SRT will be interesting. You have Neko regulated. Leo is still not regulated. I beat myself up about it. It has caused his neuropathy. With luck we will see numbers start dropping. I'll review the spreadsheets again. Post SRT I will reduce food to help drive numbers down. He has not gained weight. Still 16.5 pounds.
Little Dude the Love Bug is free of ear mites! He does have leftovers in his ears. The vet applied BNT ointment. Little Dude does NOT let us in his ears. This should fix any fungus or infection in his ears. He did have chronic ear mites when we first got him. In summary, now he can become an inside/outside cat. We will wait until I return to introduce him to Leo.
Neko was no where near regulated when we first went to CSU. She was just as likely to start her day with red or pink back then. Two days before we left she earned her first reduction, starting the day at 430, down to 49 and zooming back up by the end of the cycle - which is why we stress mid cycle tests. Levemir cats nadir later, typically +8 but many acrocats even later. Neko tends to be between +9 and +12, I can't tell from what tests you've done where Leo's nadir falls. When you get back from CSU, knowing what part of the cycle Leo tends to go low will be very important so you can keep him safe when his dose needs start to fall. I don't think reducing food is the key. As long as he's maintaining weight, I would maintain that amount of food. Unregulated cats need the food. If you can get a better idea of how he's doing on a particlar insulin dose, you can raise the dose to get him into better numbers.
In Fort Collins, there are both Petco and Petsmart on South College Way, which is the main drag near where you turn off for CSU. Lots of places to replenish supplies. The Petsmart is open quite late. Second time there I flew, and got in quite late on the Sunday cause my luggage took a different flight to Denver that I did.
Fortunately I got to Petsmart in time to get a litter box and more litter before settling into the hotel.
Good news on Little Dude - looks like he wants to be a loving indoor cat.
In Fort Collins, there are both Petco and Petsmart on South College Way, which is the main drag near where you turn off for CSU. Lots of places to replenish supplies. The Petsmart is open quite late. Second time there I flew, and got in quite late on the Sunday cause my luggage took a different flight to Denver that I did.
Fortunately I got to Petsmart in time to get a litter box and more litter before settling into the hotel.Good news on Little Dude - looks like he wants to be a loving indoor cat.
JeffJ
Very Active Member
Thanks Wendy, good advice. Lately, Leo's body just doesn't want a nadir. So I stopped fretting about it. Post SRT - I will be a testing fiend!
Thanks for the info about Petco and Petsmart. In north Austin, they are close together as well. We like Petsmart better. I'm taking full supplies up there. But I might visit the Petsmart to see their layout.
Little Dude definitely wants inside. Chinus, the female will be the issue. We had Scoobs for 7 years, and Chinus and Scoobs had pissing contests the whole time. But of course we look past that as much as we could. Yes, we have multi-cat Feliway. And lots of paper towels. We also had the whole house tiled, AND epoxy grout which was expensive. Impervious to pee though.
Thanks for the info about Petco and Petsmart. In north Austin, they are close together as well. We like Petsmart better. I'm taking full supplies up there. But I might visit the Petsmart to see their layout.
Little Dude definitely wants inside. Chinus, the female will be the issue. We had Scoobs for 7 years, and Chinus and Scoobs had pissing contests the whole time. But of course we look past that as much as we could. Yes, we have multi-cat Feliway. And lots of paper towels. We also had the whole house tiled, AND epoxy grout which was expensive. Impervious to pee though.
JeffJ
Very Active Member
Hi @Wendy&Neko and @julie & punkin (ga)
CSU called and confirmed my Monday appt. They said to withhold food the night before. How did you deal with that? This will probably be the same each day for the anesthesia and SRT.
If I withhold food but give his dose, then he could crash without the calories. Should I just skip the dose?
thanks,
jj
CSU called and confirmed my Monday appt. They said to withhold food the night before. How did you deal with that? This will probably be the same each day for the anesthesia and SRT.
If I withhold food but give his dose, then he could crash without the calories. Should I just skip the dose?
thanks,
jj
JeffJ
Very Active Member
Austin to Amarillo accomplished!
Leo:
4:30am - Theresa fed him way early. So by 9am his BG = 200
9:00am - fed and dosed
9:15am - peed in the litter box, YAY
9:30a - 6:30p - 9 hour trip with 5 minute stops, 470 miles
- ate only 1 can Fancy Feast with water
- would not pee in the litter box
AMPS +4 = 200
GOOD BOY Leo - he peed in the litter box in the hotel room. Such a sweetie.
Poor Leo. He doesn't like the car, but settled down after 1 hour. He hyperventilated the first few hours. But he did seem to like looking outside. Did not cry after first hour. My good boy.
Of note:
- wind farm at San Saba, 1000's of giant wind turbines, harnessing energy
- full grown jack rabbit safely crossed the road way ahead of me. I slowed down as I got near. They are huge, and those ears, wow.
- East and north east Texas fairly wet this year. Lots of lush crop fields and weeds. I saw a lot of cotton fields.
Picture: JJ and Leo getting loaded into the car.
Leo:
4:30am - Theresa fed him way early. So by 9am his BG = 200
9:00am - fed and dosed
9:15am - peed in the litter box, YAY
9:30a - 6:30p - 9 hour trip with 5 minute stops, 470 miles
- ate only 1 can Fancy Feast with water
- would not pee in the litter box
AMPS +4 = 200
GOOD BOY Leo - he peed in the litter box in the hotel room. Such a sweetie.
Poor Leo. He doesn't like the car, but settled down after 1 hour. He hyperventilated the first few hours. But he did seem to like looking outside. Did not cry after first hour. My good boy.
Of note:
- wind farm at San Saba, 1000's of giant wind turbines, harnessing energy
- full grown jack rabbit safely crossed the road way ahead of me. I slowed down as I got near. They are huge, and those ears, wow.
- East and north east Texas fairly wet this year. Lots of lush crop fields and weeds. I saw a lot of cotton fields.
Picture: JJ and Leo getting loaded into the car.
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They told me I could feed until midnight, which was four hours after shot time, so Neko got all her food in her before calling it a night. We also did just half dose in the morning. If I was worried about how low she'd go at night after midnight, I gave her higher carb food for her before bed snack. Sorry not to respond earlier, power outage here.
Nice to see Leo found the blues.
Guess he likes travelling.
Nice to see Leo found the blues.
Guess he likes travelling.
JeffJ
Very Active Member
Thanks Wendy for the info. Yes, Leo's BG seemed to align very well with travelling. I hope your power is back on for good.
On Little Dude:
Theresa let him in as soon as we left. He is exploring inside. She said he likes to be outside. She has lured him to the backyard which will now be his new safe center of operations. We are overjoyed with his progress and his integration into our family. It will be interesting for Leo to come home and meet Little Dude. Leo is very friendly, so we expect the continued problem will be Chinus (female siamese) not accepting Little Dude.
On Little Dude:
Theresa let him in as soon as we left. He is exploring inside. She said he likes to be outside. She has lured him to the backyard which will now be his new safe center of operations. We are overjoyed with his progress and his integration into our family. It will be interesting for Leo to come home and meet Little Dude. Leo is very friendly, so we expect the continued problem will be Chinus (female siamese) not accepting Little Dude.
JeffJ
Very Active Member
Day 1 Travel went well, summarized above.
Day 2 Prep and Travel starts.
Leo slept well, and only cried a couple times at night. He got food at 4:30am.
AMPS = 305.
Dose 1 = 18.0 @8:30am
Good boy Leo. He peed and pooped in the litter box. Who could ask for more?
Well he gave me more - a bunch of leg lovin's and a bunch of purrs. What a heart of gold.
Prep time now, then Day 2 Travel from Amarillo, TX to Ft. Collins.
Day 2 Prep and Travel starts.
Leo slept well, and only cried a couple times at night. He got food at 4:30am.
AMPS = 305.
Dose 1 = 18.0 @8:30am
Good boy Leo. He peed and pooped in the litter box. Who could ask for more?
Well he gave me more - a bunch of leg lovin's and a bunch of purrs. What a heart of gold.
Prep time now, then Day 2 Travel from Amarillo, TX to Ft. Collins.
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JeffJ
Very Active Member
Day 2 - Travel to Ft. Collins
Leo has been such a good boy. He used the litter box only after we got to the hotel. No car accidents - what a good boy! He is back at BG=300, so feeding him well tonight. We are in a Motel 6 clone, pretty shabby but I only care if the internet works. We are unpacked and settled in for the week.
Trip summary:
- Day 1: 9 hours, more stops than day 2, 470 miles
- Day 2: 473 miles in 7.5 hours = 63 mph average
- Total: 943 miles in 16.5 hours = 57 mpg avg total
Leo:
- Leo hardly cried at all
- He hyperventilated a long time, but finally fell asleep
- He got fed twice during short stops.
- He would not use the litter box
- He would not drink any water, so I put extra water in the food
- No issues during the drive
- Eastern Colorado is sparsely populated and pretty boring
- North Texas was more populated, and more heavily farmed with crops and cows
- This must be a green year. Most of the weeds and shrubs all looked pretty green.
Pic: Leo in southern Colorado, off of 287, just finished a 5 minute food break.
There are 30+ twist ties and velcro on the cage. It took over an hour during trip prep. There is not a single rattle - so we are still sane as a result.
Leo has been such a good boy. He used the litter box only after we got to the hotel. No car accidents - what a good boy! He is back at BG=300, so feeding him well tonight. We are in a Motel 6 clone, pretty shabby but I only care if the internet works. We are unpacked and settled in for the week.
Trip summary:
- Day 1: 9 hours, more stops than day 2, 470 miles
- Day 2: 473 miles in 7.5 hours = 63 mph average
- Total: 943 miles in 16.5 hours = 57 mpg avg total
Leo:
- Leo hardly cried at all
- He hyperventilated a long time, but finally fell asleep
- He got fed twice during short stops.
- He would not use the litter box
- He would not drink any water, so I put extra water in the food
- No issues during the drive
- Eastern Colorado is sparsely populated and pretty boring
- North Texas was more populated, and more heavily farmed with crops and cows
- This must be a green year. Most of the weeds and shrubs all looked pretty green.
Pic: Leo in southern Colorado, off of 287, just finished a 5 minute food break.
There are 30+ twist ties and velcro on the cage. It took over an hour during trip prep. There is not a single rattle - so we are still sane as a result.
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Glad you made it OK. Good boy Leo.
JeffJ
Very Active Member
Thanks Wendy. Since Leo doesn't drink water or eliminate, it rules out the potential for a 15 hour straight thru drive. Plus, hypothetically, it would be harder to speed during the evenings when you can't see highway patrol. Just hypothetically of course.
Monday 10:45 am appointment.
Leo dosed 18.0 units tonight, and overfed on purpose. He is snoozing. He will be whining in the morning for food.
Monday 10:45 am appointment.
Leo dosed 18.0 units tonight, and overfed on purpose. He is snoozing. He will be whining in the morning for food.
JeffJ
Very Active Member
Day 1 at CSU summary:
- Weather is stellar, 45 at night, 90 at mid-day, hardly any clouds.
- The CSU vet campus is easy to find, and easy to park at.
- Leo is doing great, he is getting used to the vets poking and prodding.
- A Walmart superstore is nearby. I got food and supplies there.
Day 1 Monday
- 4:30am Leo "Dad I'm hungry"
- 4:45am Leo "Dad, I just stunk up the litter box, please clean it, or not."
- 5:00am-7:00am "Dad I'm really hungry"
"If I walk all over you and pester you, will you please get up and feed me???"
- No food for Leo each morning, so that was fun today, and the rest of week
Day 1 at CSU Veterinarian Teaching Hospital
- 10:45 am check in, completed by 3:00pm
- General health and Acromegaly checked, and confirmed
- Leo's front jaws show obvious box-like structure typical of Acro
- I declined additional tests until CT scan is done
- Example: blood workup & diagnostic profile; which has already been done
- Ultrasound declined
- Patient cost estimate detailed, then I signed
- Day 1 is for CSU.
Leo is assigned two people:
a) post-doc resident, veterinarian graduate, a full general vet
b) 4th year vet student, resident, as an assistant
- These 2 gentle people are assigned for the full week
Day 2 Tuesday 7:30am
- Leo will be sedated
- CT scan will be done to image the tumor
- If indistinct, then MRI will also be done
- By the end of Tuesday, SRT (radiation) plan will be created
Days 3-5 (Wed - Fri)
- radiation each day, starting at 7:30am, and lots of waiting
Pic from Monday 9/19- Leo tired from excitement and super high BG.
.
- Weather is stellar, 45 at night, 90 at mid-day, hardly any clouds.
- The CSU vet campus is easy to find, and easy to park at.
- Leo is doing great, he is getting used to the vets poking and prodding.
- A Walmart superstore is nearby. I got food and supplies there.
Day 1 Monday
- 4:30am Leo "Dad I'm hungry"
- 4:45am Leo "Dad, I just stunk up the litter box, please clean it, or not."
- 5:00am-7:00am "Dad I'm really hungry"
"If I walk all over you and pester you, will you please get up and feed me???"
- No food for Leo each morning, so that was fun today, and the rest of week
Day 1 at CSU Veterinarian Teaching Hospital
- 10:45 am check in, completed by 3:00pm
- General health and Acromegaly checked, and confirmed
- Leo's front jaws show obvious box-like structure typical of Acro
- I declined additional tests until CT scan is done
- Example: blood workup & diagnostic profile; which has already been done
- Ultrasound declined
- Patient cost estimate detailed, then I signed
- Day 1 is for CSU.
Leo is assigned two people:
a) post-doc resident, veterinarian graduate, a full general vet
b) 4th year vet student, resident, as an assistant
- These 2 gentle people are assigned for the full week
Day 2 Tuesday 7:30am
- Leo will be sedated
- CT scan will be done to image the tumor
- If indistinct, then MRI will also be done
- By the end of Tuesday, SRT (radiation) plan will be created
Days 3-5 (Wed - Fri)
- radiation each day, starting at 7:30am, and lots of waiting
Pic from Monday 9/19- Leo tired from excitement and super high BG.
.
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julie & punkin (ga)
Very Active Member
I'm so sorry to be so late responding. We had a family friend pass away and things have been a bit crazy here. In any case, I'm glad you made it to CSU ok.
Punkin also had a reduction almost immediately after the SRT - the numbers will guide you on what to do. Just be aware that some cats react soon after the SRT, some take longer. Your nadir checks will give you the information you need to be able to adjust the dose.
Good luck tomorrow. I loved the folks at CSU - they were so competent and professional. I hope your experience is just as good and Leo does well with all of the radiations.
Punkin also had a reduction almost immediately after the SRT - the numbers will guide you on what to do. Just be aware that some cats react soon after the SRT, some take longer. Your nadir checks will give you the information you need to be able to adjust the dose.
Good luck tomorrow. I loved the folks at CSU - they were so competent and professional. I hope your experience is just as good and Leo does well with all of the radiations.
JeffJ
Very Active Member
Leo and I are blessed. The CSU team is comprised of people that care. From the front desk, to the billing, to the vets and the interns. It is overwhelming to have such great people helping us. I don't know if they even realize how much this means to Theresa and I. And to Leo, they are saving his life. We are fortunate to have the funding to pay for it, to live in an age where the technology and people can treat him, and to live in a country where the treatment is available.
From left to right, Radiation team:
- Dr. Beatrix Jenei, Resident, Radiation Oncology
- Dr. Carolynne Kruchman, Resident, Radiation Oncology
- Dr. Lynn Griffin, Staff, Resident Radiologist
- Dr. Tiffany Wormhoudt, Resident, Radiation Oncology
- JJ
Pic 2:
- JJ and Sarah Von Mater, 4th year resident veterinarian - assigned to me and Leo all week
and Leo's pituitary scan to the right
I do not have a pic of Dr. Jacob Cauley, resident. But he is great as well.
@julie & punkin (ga)
Dr. Griffin is the staff full time radiologist. She treated Punkin. She said "Tell Julie Hi from Dr. Griffin".
From left to right, Radiation team:
- Dr. Beatrix Jenei, Resident, Radiation Oncology
- Dr. Carolynne Kruchman, Resident, Radiation Oncology
- Dr. Lynn Griffin, Staff, Resident Radiologist
- Dr. Tiffany Wormhoudt, Resident, Radiation Oncology
- JJ
Pic 2:
- JJ and Sarah Von Mater, 4th year resident veterinarian - assigned to me and Leo all week
and Leo's pituitary scan to the right
I do not have a pic of Dr. Jacob Cauley, resident. But he is great as well.
@julie & punkin (ga)
Dr. Griffin is the staff full time radiologist. She treated Punkin. She said "Tell Julie Hi from Dr. Griffin".
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JeffJ
Very Active Member
Hi Julie - I am sorry to hear about your friend. Dr Griffin said to tel you "hi" !!!
I will be going to California and Washington next week. Jennifer and I will handle my Mom's estate. Dr Griffin said typically the BG drops slowly after one or two weeks. Theresa will be handling Leo. And we have cell phones. After Oct 5, I will stay in Austin for ONE YEAR.
I will be going to California and Washington next week. Jennifer and I will handle my Mom's estate. Dr Griffin said typically the BG drops slowly after one or two weeks. Theresa will be handling Leo. And we have cell phones. After Oct 5, I will stay in Austin for ONE YEAR.
JL and Chip
Very Active Member
We're they able to see tumors on Leo's CT scan? Did they also do an MRI?
Here's hoping tomorrow is smooth and uneventful.
Here's hoping tomorrow is smooth and uneventful.
JeffJ
Very Active Member
Day 2 CSU
Great news. Leo has a resolvable Pituitary Gland tumor. My sweet boy.
Resolved via CT scan.
His treatment options are great. SRT will start tomorrow (Wednesday 9/21/2016)
Leo didn't like the anesthesia, but is eating like a pig. His BG is 400+ all day.
Normal cat pituitary vs Leo's.
normal = 3mm x 5mm
Leo = 5mm x 10mm
The growths are obvious even to me on the CT scan. The radiologist team, and the CSU team finds Leo very interesting because they don't get many Acro cats. The radiation will disrupt the tumor's DNA. Two or three mitosis cycles later, the tumor cells stop regenerating.
Days 3,4,5 (Wed - Fri), 9/21/2016 - 9/23/2016
SRT treatments
Day 5 CSU (9/23/2016) - will depart for Amarillo, TX around noon. They are ensuring the schedule will allow our departure on Friday.
Dr. Lynn Griffin is the resident staff radiologist. She had left CSU and is now back. It was an absolute pleasure to speak with someone who knows Acro in detail, and knows pituitary tumors in detail.
Several pics. Some guy got in the way of the CSU entrance flower pic
Great news. Leo has a resolvable Pituitary Gland tumor. My sweet boy.
Resolved via CT scan.
His treatment options are great. SRT will start tomorrow (Wednesday 9/21/2016)
Leo didn't like the anesthesia, but is eating like a pig. His BG is 400+ all day.
Normal cat pituitary vs Leo's.
normal = 3mm x 5mm
Leo = 5mm x 10mm
The growths are obvious even to me on the CT scan. The radiologist team, and the CSU team finds Leo very interesting because they don't get many Acro cats. The radiation will disrupt the tumor's DNA. Two or three mitosis cycles later, the tumor cells stop regenerating.
Days 3,4,5 (Wed - Fri), 9/21/2016 - 9/23/2016
SRT treatments
Day 5 CSU (9/23/2016) - will depart for Amarillo, TX around noon. They are ensuring the schedule will allow our departure on Friday.
Dr. Lynn Griffin is the resident staff radiologist. She had left CSU and is now back. It was an absolute pleasure to speak with someone who knows Acro in detail, and knows pituitary tumors in detail.
Several pics. Some guy got in the way of the CSU entrance flower pic
Attachments
Madrona and Leda (GA)
Very Active Member
I'm so glad that your Leo is in such good hands! What a bright recovery he has ahead of him with you to look after him.
JeffJ
Very Active Member
Hi JL - the MRI was not needed. Got lucky there. Thanks for the support.
Dr. Griffin said to quit beating ourselves up over the tardy diagnosis and treatment. I guess everyone wishes they caught it and figured it out in month 1 or 2. Leo was diagnosed with diabetes in August 2015. Acro was very low level or non-existent just 12 months ago with him.
Dr. Griffin said to quit beating ourselves up over the tardy diagnosis and treatment. I guess everyone wishes they caught it and figured it out in month 1 or 2. Leo was diagnosed with diabetes in August 2015. Acro was very low level or non-existent just 12 months ago with him.
JeffJ
Very Active Member
Someone asked me about hours at the clinic.
Hours at the clinic.
Mon - check in was 3-4 hours
Tue - CT scan 7:30am - 2pm = 6.5 hrs
Wed, Thur - SRT = 6-8 hours, start time is 7:30
Fri - SRT = 4-5 hours, start time is 7:30. I asked for special first in line on Friday so I can drive home starting Friday. They think that is viable.
Hours at the clinic.
Mon - check in was 3-4 hours
Tue - CT scan 7:30am - 2pm = 6.5 hrs
Wed, Thur - SRT = 6-8 hours, start time is 7:30
Fri - SRT = 4-5 hours, start time is 7:30. I asked for special first in line on Friday so I can drive home starting Friday. They think that is viable.
julie & punkin (ga)
Very Active Member
Aw, thanks for passing along that message. I remember Dr. Griffin - she spent quite a bit of time with us. I think she's in our CSU pics as well - the ones in my signature line about the SRT. That whole team just exuded confidence and I was so grateful for their expertise.
One thing that you really need to keep on your radar is to watch for hypo thyroid. The radiation can kill the thyroid and then the cat can need thyroid replacement. We had regular thyroid tests done and thought it hadn't happened to punkin, but it turned out that we needed different thyroid tests to catch the low thyroid, not the standard ones. On the standard senior panel, the test results kept coming back as low normal. His hair was falling out and we'd lost regulation of his blood sugar, but the tests were still showing low normal. We finally figured out (with help from Marje on a phone call from the vet's exam room) that we needed a different break-down in the test. Those results came back extremely low. We started thyroid immediately, but that was just a short time before he died. I think his thyroid had been very low for quite a while and that had caused other problems. Thyroid hormones are involved in most every area of the body - they are extremely important and when they are off, everything else is affected.
So consider yourself forewarned - stay on top of that. Here is the link to Punkin's lab page - you want to check:
What does "resolvable" mean in this context? I know the word, just am not sure what is meant here. Punkin's tumor was big and very visible - and yet the SRT didn't completely kill the tumor. In the time that I've been here, I haven't seen any acro cats go completely OTJ after SRT. We sure hoped for it, but it didn't happen. I was still happy I'd done it anyway.
One thing that you really need to keep on your radar is to watch for hypo thyroid. The radiation can kill the thyroid and then the cat can need thyroid replacement. We had regular thyroid tests done and thought it hadn't happened to punkin, but it turned out that we needed different thyroid tests to catch the low thyroid, not the standard ones. On the standard senior panel, the test results kept coming back as low normal. His hair was falling out and we'd lost regulation of his blood sugar, but the tests were still showing low normal. We finally figured out (with help from Marje on a phone call from the vet's exam room) that we needed a different break-down in the test. Those results came back extremely low. We started thyroid immediately, but that was just a short time before he died. I think his thyroid had been very low for quite a while and that had caused other problems. Thyroid hormones are involved in most every area of the body - they are extremely important and when they are off, everything else is affected.
So consider yourself forewarned - stay on top of that. Here is the link to Punkin's lab page - you want to check:
Free T4 (ng/dL)
Free T4 (pmol/L)
cTSH
Notice on the lab column for 3/1/13, Punkin's T-4 still was showing 0.8 - the low end of normal, but with the new free T4 it was actually less than 0.3, practically nothing. That's how important those break-out tests are.Free T4 (pmol/L)
cTSH
JL and Chip
Very Active Member
That's really interesting. I was just in communication with Dr. Griffin about Tubby and she mentioned the possibility of thyroid impact, though she said she's never made a cat go hypothyroid with SRT. I wonder if she knows about Punkin?
I'm frequently surprised by how often the focus is on the Total T4 -- for both dogs and cats. A lot of things can affect that value. Michigan State does a detailed thyroid panel that is supposed to be very specific in evaluating thyroid function (last I knew they were the only ones in the country performing it). I sent blood out to them for a rescue dog a few years back and it was very enlightening.
Dogs frequently develop hypothyroidism, but cats so rarely go hypothyroid naturally that it might be easy to overlook the symptoms. I'm really glad this topic came up!
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JeffJ
Very Active Member
I think by "resolveable", it was obvious to them that the pituitary had grown outside the normal boundaries. I only had an hour with them yesterday. And today, I dropped him off. There will be a discussion with them today when I pick Leo up.
That is a good heads up about the thyroid info. I will bring it up today.
That is a good heads up about the thyroid info. I will bring it up today.